Nutritional Status In The Head And Neck Cancer Patients Undergoing Radiotherapy And Effectiveness Of The Nutritional Interventions On Patients' Outcome

Background:Nutritional decline is often accepted as a part of the cancer course and its treatment.Malnutrition is the most common secondary diagnosis in patients with cancer.The prevalence of malnutrition in head and neck cancer patients were reported to be high. Malnutrition has a lot of significant negative impacts.In patients with cancer,malnutrition increases the risk of infections,treatment toxicity,health care cost and quality of life as well as survival.Over the past two decades greater attention has been focused on the strategies to manage the malnutrition.There are various interventional strategies used to support patients with a declining nutritional status.However,little studies have been done with the head and neck cancer patients in China.The researcher would describe the nutritional status of the head and neck cancer patients undergoing radiotherapy,and identify the effectiveness of nutritional interventions on the head and neck cancer patients.The result of the research will supply the baseline of supportive ways for the nutritional status as well as quality of life for cancer patients in China.Objectives:To investigate the radiation reflections,nutritional status,weight loss,nutrient intake,quality of life at the onset and at the end of radiation theropy(RT).The relationships among radiation reflection,the nutrition status,nutrient intake as well as quality of life were identified also.To explore whether the nutritional interventions in this study will be able to enhance nutrient intake and whether the latter influence the patients' quality of life.Methods:A descriptive study were used to describe the nutritional status,nutrient intake, radiation reflections,quality of life of the head and neck cancer patients undergoing radiotherapy.The purposive sampling method was used to select patients referred to radiation therapy departments of PUMC hospital,as well as the cancer special hospital from Mar 2007 to Sep 2007.The information about demographic data,disease status,SGA, anthropometric measures,albumin,24h diet recall,EORCT QLQ c-30 were gathered at onset of RT,as well as 2^nd week,4^th week and the end of RT.The sample in 2^nd part of research were all head and neck cancer patients referred to radiation therapy in the same two hospitals from Sep 2007 to Dec 2007.The information gathered was same as which in the observing group,and patients in this group received nutritional interventions.The interventional program included following steps,patients received standard nutritional education at onset of RT.Then patients in SGA-B or SGA-C levels,were transferred to nutritional doctor.It was the nutritional doctor who supplied nutritional supports according to patients' food habits and nutritional changes.The major supportive methods include diet counseling,nutritional supplyments by oral,and EN or PN.The measurement same as observational group were repeated at 2^nd week,4^th week and the end of RT.Whenever patients was in SGA-B or SGA-C,would be transferred to nutritional doctors.Result:Radiation reflections existed commonly in the head and neck cancer patients from the 2^nd week in RT,which became more serious in the 4^th week in RT.The average of weight loss in the head and neck cancer patients was 2.68kg.There was 50%patients reduced their weight more than 5%.BMI,ALB reduced significantly.The percentage of patients with malnutrition in the end of RT increased to be 90%.The energy as well as protein intake were always lower than needed.There were positive correlations between radiation reflections and energy and protein intake.The scores of each dimensions in QLQ C-30 reduced at the end of RT.The influencing factors included SGA level,weight loss,stomatitis and age of patients, which could explain the variation of QOL at 54.8%level.The nutritional interventions made little increase in protein intake,little reduction in QOL without significance.Conclusions:During RT,the head and neck cancer patients had radiation reflections commonly.The percentage of patients with malnutrition at the end of RT increased to 91%. The energy and protein intake were less than needed.The nutritional interventions made little increase in protein intake,little reduction in QOL without significance.No effectiveness might due to radiation reflection and absence of routes of nutritional support.